Symptoms and main methods of treatment for vulvovaginal candidiasis

According to statistics, 75% of women of reproductive age have had the disease at least once in their lives, and half have had a relapse. From the above we can conclude: infectious vulvovaginitis is characterized by a high frequency, as well as frequent recurrence of the process.

Candida fungus is the “culprit” of the disease

The causative agent of the disease that affects the mucous membranes of the vulva and vagina is the yeast-like fungus Candida. In healthy people, candidal fungus lives on the skin and mucous membranes and is considered opportunistic. Being a single-celled microorganism, a fungus

Candida is highly resistant to the adverse effects of environmental factors, including medications.

Infection with candidiasis often occurs in the form of an autoinfection, that is, the body’s own flora becomes the source of infection. Becoming the “culprit” of the disease, the fungus does not change its properties, but leads to a decrease in the level of local defense of the body.

Factors predisposing to the disease

Among the factors contributing to the proliferation of the fungus and, as a consequence, the development of the disease, there are:

• treatment with broad-spectrum antibiotics, which provoke disruption of the process of natural self-cleaning of the vagina;
• pregnancy, which certainly entails a change in the hormonal balance of a woman’s body;
• wearing underwear made from non-natural fabrics;
• decreased immunity due to exposure to various negative factors on the body.

Symptoms and diagnosis

The most common clinical manifestations of the disease are:

• curdled vaginal discharge in moderate or excessive amounts;
• burning and/or itching of the external genitalia;
• exacerbation of the intensity of itching after water procedures, sexual intercourse, prolonged walking, during sleep, during menstruation;
• unpleasant odor that intensifies after sexual intercourse;
• vesicular rashes.

Modern medicine has in its arsenal the following basic diagnostic methods:

• microscopy of smears and vaginal discharge is the simplest and most inexpensive diagnostic method;
• the cultural method consists of studying the seeding of material in a nutrient medium in order to determine the number, type and type of fungi, their sensitivity to antifungal agents;
• Express diagnostics is a new but rapidly gaining popularity research method. A test system with an environment favorable for the development of fungi allows you to accurately detect the presence of certain strains of fungi in the shortest possible time.
• The colposcopic diagnostic method makes it possible to determine changes in the epithelium that characterize the inflammatory process, but without identifying its cause.

Forms of candidiasis in women

1. With candidiasis, there are no symptoms, and candidal fungus is detected in small quantities in the vaginal discharge through examination.
2. A pronounced clinical picture of the disease with its inherent symptoms is an indicator of the acute form of the disease, which lasts less than 2 months.
3. If the symptoms of the disease do not disappear after 2 months, this means that vulvovaginal candidiasis has become chronic.
4. The diagnosis of recurrent vulvovaginitis is given to women if it is mycologically proven that they have had this disease 4 or more times during the year.

Drug treatment: general recommendations

Due to the widespread prevalence of the disease, the duration of its course and the large number of relapses, the pharmacological industry is replete with antimycotic drugs for the treatment of the disease. The method of treating vulvovaginal candidiasis is determined by its clinical form. The main goal of therapy is to destroy the infectious agent.

Since establishing a diagnosis of vulvovaginal candidiasis is a fairly simple task, most patients get rid of the disease by using antifungal agents.

But since traditional local therapy can cause a number of unpleasant side effects, such as a burning sensation in the vagina, frequent urination, and others, many patients often stop treatment immediately after the disappearance of visible and tangible signs of an unpleasant illness. And then the causative agent of the disease is not completely destroyed.

In addition, the intestines are an excellent environment for candida colonization. Therefore, it is necessary to combat infectious agents in the gastrointestinal tract. For this purpose, the use of non-absorbable oral antimycotics is provided.

Therapy in special cases

Therefore, in order to reduce the likelihood of relapse, the attending physician must always use systemic treatment, which involves both the destruction of the pathogen itself and the impact on all possible reservoirs for colonization by yeast-like fungi. An exception is therapy during pregnancy.

As already mentioned, pregnancy is one of the main factors predisposing to vulvovaginitis. The most important requirement when treating a disease in pregnant women is its guaranteed safety, both for the woman herself and for the unborn child. Because of this, most doctors are inclined only to local treatment of the disease in this category of patients.

Medicines to help

Fluconazole preparations

Today there are a huge number of fluconazole drugs. Their high efficiency has been proven. When using such medications in the fight against vulvovaginal candidiasis, it is worth considering the fact that the effectiveness of treatment will increase by another 10-12% if fluconazole is taken twice with an interval of five to six days.

Fluconazole is also indicated as a preventive measure in the treatment of recurrent candidiasis. This drug is well tolerated and rarely causes side symptoms. But its use in the treatment of women during pregnancy and lactation is unjustified.

Pimafucin

Pimafucin is a well-known drug from the group of polyene antibiotics, which are widely used in the fight against vulvovaginal candidiasis. Due to the fact that pimafucin does not negatively affect the development of the embryo, it is often prescribed to pregnant and lactating women with a maximum allowable dose of 100 mg per day.

Gyno-travogen

Gyno-travogen is available in the form of vaginal suppositories. This drug also belongs to the group of polyene antibiotics and has a destructive effect on candidal fungus. Symptoms of the disease can significantly decrease after the first use of the drug.

Terzhinan

Terzhinan is a combined local drug with low systemic absorption rates. It will help cure both vulvovaginitis of mixed origin and candidal vulvovaginitis.

In current conditions, terzhinan is one of the few drugs for topical use that has a wide range of effects.

Although a sufficient number of successfully used treatment regimens for infectious vulvovaginitis have been developed, only a doctor can choose the ideal combination of drugs.

After all, each case of the disease is purely individual, and the methods and methods of treatment are based on the results of a study of the severity of the disease, taking into account the presence of mixed infection and other concomitant diseases of each individual patient.

Only the use of such a comprehensive individual approach in the fight against the disease guarantees high effectiveness of therapy for vulvovaginal candidiasis and can significantly reduce the frequency of relapses of the disease. Also, in order to avoid a new infection, it is recommended to treat both regular sexual partners simultaneously.

Disease prevention

• strictly observe the rules of intimate hygiene;
• balance your diet by including yogurts, vegetables and fruits in your diet;
• is selective in the choice of sexual partners, avoiding casual contacts;
• use a condom as a method of protection against all kinds of infections;
• avoid stress, nervous and physical strain.
• limit douching and do not self-medicate;
• use the least scented tampons and pads;
• Avoid clothes made from synthetic fabrics that are too tight.

Vulvovaginal candidiasis serves as a marker of human health problems. Therefore, every woman should regularly monitor her own health in general, and intimate health in particular.

Source: http://griboks.ru/kandidoz/zhenshhiny/kandidoznyj-vulvovaginit.html

Signs and treatment of vulvovaginal candidiasis

Vulvovaginal candidiasis is also called genital candidiasis; it is an infection of the genital organs and vaginal mucous layer by Candida fungi.

The disease is very widespread, accounting for at least a third of all infectious pathologies of the genital organs in the fair sex.

At the same time, women of childbearing age are more often affected - according to statistics, 75% have been ill at least once, and 50% have had a relapse.

The fungus itself is a conditionally pathogenic unicellular microorganism and lives on the skin and mucous membranes of completely healthy people; it is resistant to the negative effects of external environmental factors, including pharmaceuticals. By provoking vulvovaginal candidiasis, the fungus itself does not change its properties, but reduces the level of the body’s natural defenses.

Forms of the disease and causes of its development

There are several clinical forms of vulvovaginitis, depending on the nature of the pathology:

• In the acute stage, the duration of the disease is no more than two months, the signs of pathology are quite pronounced.
• In the chronic relapsing form, the disease can last more than two months, or the number of relapses, which is confirmed by test results, is four or more cases during the year. Signs of pathology are insignificant or completely hidden.
• With candidiasis, there are no subjective manifestations; when examining the vagina, the specialist does not find any visible abnormalities. However, when considering the test results, certain deviations are noted. If there are no complaints from the patient, medications are not used for this form of pathology.

Proven fact. Asymptomatic thrush is detected in women of childbearing age in almost 20% of cases. The only recommendations for candidiasis are strengthening the immune system and preventive measures taken before planning pregnancy.

Reasons for the development of the disease

When considering the disease, we can come to the conclusion that the main cause of candidal infection is the deterioration of the body’s defense system. This phenomenon can be caused by numerous factors, including:

• Prolonged wearing of synthetic underwear, which increases the temperature at the points of contact with the body, disrupts the necessary air supply.
• Pathologies that worsen the immune response, including tuberculosis, AIDS and hepatitis, and other diseases.
• The use of antimicrobial pharmaceuticals, given that they kill lactobacilli, provoking the unhindered proliferation of fungi.
• The use of certain drug groups, in particular immunosuppressants, radiation and chemotherapy.
• Sexual contact with a carrier of a pathogenic pathogen - despite certain doubts among experts regarding this method, the frequency of such infection is quite high.
• Diseases of the endocrine system, including the presence of diabetes and hormonal imbalance in general.
• Impaired functionality of the digestive system.
• The period of bearing a child, especially at the beginning and end of pregnancy. At this time, there is a noticeable decrease in immunity in the genital area, which is necessary to prevent rejection of the fertilized egg.

Additional influencing nonspecific factors are abuse of flour products and sweets, hypothermia affecting the pelvic organs, recent infection with viral or bacterial infections.

Signs of the disease

As vulvovaginal candidiasis develops, it is accompanied by a number of clinical signs. Moreover, their severity depends on the stage of the pathology.

Thus, in the acute form of the disease, pathological discharge can be very abundant, the tissues become swollen and reddened, and severe itching is constantly observed.

If there is no adequate treatment at this stage, the disease becomes chronic, and the damage to the mucous layers becomes deeper, spreading to tissues located quite far from the initial focus.

However, in most cases there are no such complications and everything is limited to less severe symptoms. Considering the emerging signs in more detail, you can make a list of the most common signs indicating the presence of thrush:

• Leucorrhoea, discharged from the genital tract, having a white or yellow tint, a thick or cheesy consistency, and an unpleasant, sour odor. They can be moderate or very abundant. Before the onset of menstruation, the volume of discharge may increase noticeably.
• There is a certain discomfort in the genital area.
• Another characteristic sign indicating vulvovaginitis is itching or a burning sensation. The intensity of unpleasant manifestations increases after water procedures, physical activity, in the evening and at night, with prolonged walking and during or after sexual intercourse.
• During urination, there is a stinging, burning or pain.

Manifestations and treatment of vulvitis in women

Upon examination, discharge is found on the mucous layers of the vagina and the skin of external organs. There is a noticeable reddening of the layers, their swelling, and vesicular rashes are observed. Grayish-white coatings in the form of films may be observed on the mucous layers of the vulva or vagina.

Their shape can be round and reach a diameter of 5 or 7 mm, having clear boundaries and a grayish and white color. The layer around such a formation is hyperemic. If you try to separate the plaque, an erosive surface is discovered underneath it. In some cases, adjacent lesions are capable of merging.

Cracks may be found in these same areas.

Important! If vulvovaginal candidiasis develops into a chronic form, the whitish discharge may be insignificant, dryness of the mucous layers occurs, symptoms indicating their atrophy, pigmentation of the skin, and its thickening.

Diagnosis of the disease

Before prescribing treatment, it is necessary to confirm assumptions regarding the pathology. For this purpose, there are certain methods for studying biological materials, including:

• Microscopic examination of collected smears and vaginal discharge, which determines the presence or absence of fungus. This diagnostic method is the most inexpensive and simplest.
• With the cultural method, the seeding of biomaterial, previously placed in a nutrient medium, is examined. Its main goal is to determine the number and type of microorganisms and their sensitivity to drugs.
• Express diagnostics is a recently developed method that is quickly gaining popularity. This method is based on the use of a test system with an environment favorable for the proliferation of fungal infections. It allows you to determine the presence of different strains in a short time.
• Colposcopy reveals changes affecting the epithelium, but the causes of inflammation are not established.

Treatment

As for the treatment of the disease, it is carried out only in the presence of clinical symptoms confirmed by test results. The developed therapeutic regimen is always individual and based on the clinical picture and causative risk factors.

There are a number of principles on which modern treatment of the disease is based. In particular, we are talking about the need to destroy pathological fungal microorganisms against the background of partial or complete elimination of predisposing factors. In parallel with treatment, the immune system should be strengthened.

Now about the drugs - most often in the development of vulvovaginal candidiasis they use:

• Polyene antimicrobial drugs, in particular Levorin, Nystatin, Mycoheptin and others.
• Among the triazole drugs, Fluconazole or Itraconazole predominate.
• Of the imidazole drugs, preference is given to Miconazole, Ketoconazole, Econazole and others.
• Prescribed drugs from the group of allylamines, including Terbinafine or Naftifine.
• Among the combination drugs are Polygynax, Klion-D and Terzhinan.
• Drugs included in other groups include iodine preparations, Nitrofungin, Amorolfine, Ciclopirox and others.

As a rule, the cream is prescribed for vulvitis or uncomplicated vulvovaginitis, if the disease was detected in the early stages of development. In case of pathology with obvious signs, the use of local and general medications will be required.

What drugs are most often used in the treatment process?

Modern medicine in many cases prefers to treat acute and chronic forms with the use of Fluconazole. In case of an acute course, it is prescribed orally, a single dosage is 150 mg.

If there is a need to eliminate relapses in the chronic form, the drug is prescribed in two or three doses with an interval of at least two or three days between them. The dosage of the product is 150 mg.

Additionally, it is recommended to use antifungal drugs in the form of suppositories, solutions, creams, and vaginal tablets. The duration of therapy can range from one day to ten days.

If we consider the drugs used in therapeutic regimens in more detail, it can be noted that the most popular are those that contain Fluconazole.

The demand for such drugs is justified by their high effectiveness - when used correctly with twice a dose and an interval between use of five or six days, the effectiveness increases by 10-12%. Fluconazole is also used as a preventive measure in the treatment of recurrent thrush.

The advantage of the drug is that it is well tolerated by patients and has an almost complete absence of side symptoms. The downside of the product is that it is not advisable to use it during pregnancy and breastfeeding. In addition to the considered means, they use:

• Pimafucin is considered a fairly well-known antibiotic. Due to the fact that its use does not have a negative effect on the developing fetus, the drug is often prescribed to pregnant women and during breastfeeding. The maximum daily dosage is 100 mg.
• The drug Gino-travogen is produced in the form of vaginal suppositories; it is classified as a polyene antibiotic. When using the drug, the destruction of Candida fungi begins, and the signs of the disease can noticeably decrease after the first dose of the substance.
• Terzhinan is a combined topical agent. Its distinctive feature is low rates of systemic absorption. The drug is used both for the treatment of vulvovaginitis candidiasis and diseases of mixed origin. Its spectrum of effects is quite wide, and the composition is chosen so well that the product can be used in the treatment of women carrying a child and breastfeeding it.

Important. Despite the wide choice of drugs that can be used to effectively treat vulvovaginitis, the preparation of individual therapeutic regimens and the prescription of drugs is the responsibility of the attending physician.

A mandatory condition that must be observed during therapy is the absence of sexual contact while simultaneously treating the victim and his partners. Traditional medicine recipes can be used as additional remedies.

Herbal decoctions and infusions are used that can fight inflammatory processes; the list of useful plants includes chamomile, sage, St. John's wort and others.

Which vaginal suppositories to choose for vaginitis

As practice shows, vulvovaginal candidiasis is treated very successfully and quite quickly, but only if therapy is started in a timely manner. If this condition is not met, the disease develops into a chronic or recurrent form, and the duration of treatment increases accordingly.

Pathology during pregnancy

Statistics show that among women carrying a child, cases of thrush are observed in 40%. The reason lies in favorable conditions for the proliferation of fungi that occur in their body:

• Hormonal levels change significantly.
• There is hypertrophy and loosening of the epithelium of the mucous layers of the genital tract.
• The concentration of glycogen in the cells increases, which is a nutrient medium not only for lactobacilli, but also for pathogenic microorganisms.
• The functionality of the immune system deteriorates.

Thrush with severe symptoms can significantly disrupt the quality of pregnancy, while simultaneously negatively affecting the fetus. The risk of spontaneous abortion in the early stages of pregnancy increases by one and a half times.

The risk of infection of the embryo and its intrauterine death increases two and a half times. The risk of endometritis formation after childbirth, erosion of the uterine cervix, and scarring of the skin around the vagina also increases.

During labor, the child may become infected with the formation of conjunctivitis, damage to his skin and mucous layers of the larynx, oral cavity, lungs and other negative manifestations.

Timely treatment of pathology, organized in the 1st trimester of pregnancy, significantly reduces the risks of complications, however, carrying out therapy is accompanied by certain difficulties, given that:

• antifungal agents are toxic to the pregnant child;
• In the body of pregnant women, types of microorganisms that are resistant to the effects of specific drugs are often observed.

When vulvovaginitis is detected in a woman bearing a child, the therapeutic regimen depends on the severity of the infection and the timing of pregnancy. If we are talking about the first trimester, only local treatment is allowed; the use of antimicrobial drugs is indicated only when Candida fungi are detected in the body. The secondary type of pathology involves treatment of the underlying disease.

Any treatment method requires taking into account all possible risks. The list of approved therapeutic methods includes the use of antifungal and antimicrobial agents, and hormone substitutes. Douching with antiseptic solutions is allowed; the vaginal microflora is restored through the application of probiotics.

It is necessary to eliminate foreign bodies, allergens and other irritating factors. The duration of treatment is usually 14 days, after which all tests are required.

Preventive measures involve strict adherence to intimate hygiene, a balanced diet including an increased amount of vegetables, fruits and dairy products in the menu. Careful selection of sexual partners and the use of barrier contraceptives are necessary.

Source: https://venerbol.ru/vaginit/kandidoznyj-vulvovaginit-chto-ehto-lechenie.html

Vulvovaginal candidiasis - and again about fungi called Candida

One of the most common reasons for visiting obstetrician-gynecologists and dermatovenerologists is vulvovaginal candidiasis, which has remained a pressing problem for many years. Despite the achievements of modern pharmacotherapy, over the last decade the frequency of this pathology not only has not decreased, but, on the contrary, has increased significantly (3-4 times).

Among genitourinary infections, fungal vulvovaginitis is in second place (after bacterial vaginosis). Its prevalence among women of reproductive age ranges from 25 to 40%.

The disease affects about 80% of women at least once, of which almost 45% have at least one exacerbation.

In 5-10% of patients with vulvovaginal candidiasis, the infectious process becomes chronic.

What is vulvovaginal candidiasis

The disease is a lesion of the mucous membranes of the lower genitourinary tract, the skin of the external genitalia and the perianal area, caused by excessive growth of yeast fungi of the genus Candida. In almost 90% of cases, the cause is a yeast-like fungus of the albicans species, in other cases - other types of fungus of the genus Candida. According to existing classifications, they do not belong to sexually transmitted infections. However, this does not exclude the development of candidal balanoposthitis in male partners.

Fungal pathogens of vulvovaginitis belong to saprophytes, that is, opportunistic microorganisms that normally live on the skin and mucous membranes of healthy people. Their activity (virulence) and reproduction are prevented by:

• normal composition of microflora that has competitive adhesive qualities, exhibits antagonistic activity, produces lysozyme, and also contributes to the formation of an acidic environment in the vagina due to participation in the formation of lactic acid and the production of hydrogen peroxide;
• local antimicrobial and antifungal factors that are synthesized by the healthy vaginal mucosa - lactoferin, ceruloplasmin, lysozyme, specific proteins, etc.;
• general and local immune systems, realized by macrophages, T-lymphocytes, neutrophils, immunoglobulins. The main role of the immune system in this case is mainly to block the receptors of pathogens and their lytic (dissolving) enzymes.

The cause of inflammatory processes is the transformation of saprophytic forms into virulent ones, as well as self-infection from foci located outside the genitourinary tract.

The development of the disease is caused by excessive colonization of the infection as a result of a decrease in the resistance (stability, resistance) of the mucous membrane of the genital tract, which determines the resistance of its epithelium to colonization by pathogenic and opportunistic microflora.

Thus, a decrease in the resistance of the macroorganism is a trigger factor for the development of vulvovaginal candidiasis. The causative conditions for this are:

1. Menstruation and pregnancy.
2. Minor traumatic injuries to the genital tract and inflammatory processes in them, as well as in the uterus and appendages, sexually transmitted infections.
3. Use of intrauterine contraceptives.
4. Incorrect use of oral contraceptives containing high doses of estrogens. The latter have a direct stimulating effect on the growth of yeast-like fungi and increase the efficiency of their binding to epithelial cells of the mucous membrane.
5. Lack of hygiene measures and prolonged wearing of tight-fitting underwear made of synthetic materials.
6. Promiscuous sexual life with frequent changes of sexual partners.
7. Immune and endocrine disorders, especially diabetes and hypothyroidism, as well as autoimmune connective tissue diseases.
8. The use of immunosuppressants, radiation and chemotherapy, glucocorticosteroids.
9. Diseases of the digestive tract that contribute to the development of dysbiosis.
10. Frequent and incorrect use of antibiotics not only orally and parenterally, but also externally and locally.
11. Some types of professional activities that lead to infection are work in fruit and vegetable processing plants, in factories for the production of biological products and protein-vitamin supplements, antibiotics.

In recent years, chronic resistant vulvovaginal candidiasis has become increasingly common, and it is difficult to treat using even modern antimycotic drugs. The reasons for this are:

• mutation of fungal cells, as a result of which the latter synthesize enzymes that create an obstacle to the functioning of transport systems;
• very rapid reproduction by a mutated fungal culture of its intracellular structures, which are not affected by antifungal drugs;
• the appearance of fungal cells containing a large number of pumps that eject the drug that has penetrated into it from the cell;
• a change in the structure of the enzyme targeted by the medicinal drug, as a result of which the possibility of their connection is lost;
• the presence in fungal cells of enzymes that are alternative to the lost one and compensate for the function of the latter.

Depending on the vaginal microflora, there are two forms of fungal vaginal infection:

1. True candidomycosis, in which yeast-like fungi are the only causative agent of the pathology; in this case, a high degree of concentration (in vaginal smears) of fungi is combined with that of lactobacilli.
2. A combination of bacterial and candidal types of vulvovaginitis, while in the studied material the growth of a strictly anaerobic (obligate) infection significantly prevails over the growth of fungi.

Vaginal candidiasis (thrush)

Vulvovaginal candidiasis during pregnancy

Pregnancy, even if occurring physiologically, occupies one of the leading places among other reasons contributing to this disease. The frequency of fungal infection among pregnant women reaches 40%, which is almost 3 times higher than in non-pregnant women. Moreover, among the former, the frequency of both asymptomatic and clinically pronounced and recurrent forms of vulvovaginal candidiasis is increasing.

This is explained by the favorable conditions for the growth and reproduction of fungal infections that form in the body of pregnant women:

• changes in hormonal levels;
• physiological inhibition of cellular immune mechanisms necessary for the development of immune susceptibility by the body of a pregnant woman to the developing body of the fetus;
• loosening of the epithelial layer of the mucous membrane of the genital tract and its hypertrophy;
• increasing the glycogen content in cells, which provides a nutrient medium for both lactobacilli and yeast fungi.

Candidomycosis with severe subjective symptoms can lead to a significant disruption in the quality of pregnancy.

However, what is even more important is that it poses a serious threat to the pregnancy itself and the fetus: the risk of spontaneous abortion in the early stages and its premature termination increases 1.5 times, infection and intrauterine death of the fetus increases 2.5 times, premature childbirth

Timely treatment of vulvovaginal candidiasis in the first trimester, even in asymptomatic carriers of the infection, leads to a significant reduction in the incidence of obstetric and gynecological complications. However, the treatment of this disease presents certain difficulties, mainly for two reasons:

• antifungal drugs are toxic to the fetus;
• During pregnancy, forms of fungal infection resistant to specific therapy are often encountered.

Clinical signs

Depending on the nature of the course of the disease, the following clinical forms are distinguished:

1. Acute, in which the duration of the disease does not exceed 2 months.
2. Chronic relapsing - the duration of the disease is more than 2 months or the number of relapses confirmed by laboratory tests is 4 or more over the course of 1 year.
3. Asymptomatic, or candidiasis, which is detected (according to some authors) as a result of examination in 20% of women of reproductive age and, in fact, is not a pathology. However, this form, in the presence of contributing factors, can transform into a clinically significant disease.

The most common subjective symptoms of vulvovaginal candidiasis in the acute course and during periods of relapse in the chronic course:

1. Moderate or copious yellowish or white discharge from the genital tract, having a cheesy or thick creamy character and an unpleasant sourish odor. As a rule, before menstruation, the discharge intensifies.
2. Feeling of discomfort in the external genital area.
3. Burning sensation and/or itching in the mucous membranes and skin of the external genitalia and anogenital area. The intensity of these sensations increases after water procedures and physical activity, in the afternoon and at night, during long walking, during and after sexual intercourse.
4. Dyspareunia.
5. Dysuric phenomena in the form of burning, stinging and pain during urination.

Symptoms upon examination:

1. The discharge described above on the mucous membranes of the vagina and the skin of the external genitalia.
2. Redness and swelling of the mucous membranes of the vagina with vesicular rashes on them, the labia and the skin of the perianal area.
3. Plaques on the mucous membranes of the vagina and vulva, looking like grayish-white films. They are cheesy in nature, oval or round in shape with a diameter of up to 5-7 mm and clear outlines, grayish-white in color. The mucous membrane around them is hyperemic. When plaque is separated from the mucous membrane in the acute stage of the disease, an erosive surface is exposed. Individual lesions sometimes merge with each other.
4. Cracks in the same sections, as well as in the area of ​​the posterior vaginal commissure.
5. In the chronic recurrent form of the disease, slight whitish discharge, signs of atrophy and dryness of the mucous membranes, as well as lichenification (dryness and increased skin pattern, thickening and sometimes hyperpigmentation) are observed.

Confirmation of the diagnosis is carried out through a microscopic examination of a smear, which determines the presence of a yeast-like fungus, its pseudomycelia and spores, a large number of lactobacilli and, possibly, obligate anaerobic bacteria.

If microscopy results are negative and symptoms are present, a cultural (microbiological) study is performed, which involves growing on a nutrient medium and studying microbial colonies. The species of the fungus is determined (if necessary) using the polymerase chain reaction (PCR) method.

Principles of modern therapy

Treatment of vulvovaginal candidiasis is indicated only in the presence of clinical manifestations of the disease, confirmed by microscopic and cultural studies. The choice of treatment regimen is always individual and depends on the clinical form and the presence of causative risk factors. The principles on which modern therapy is based are as follows:

1. Complete destruction of pathogens.
2. It is possible to minimize the influence of predisposing factors or completely eliminate them.
3. Increasing the degree of immune resistance of the body.

The main antifungal drugs used are:

• polyene antibiotics - Mycoheptin, Natamycin, Levorin, Amphotericin B, Nystatin;
• imidazole drugs - Ketoconazole, Butoconazole, Miconazole, Econazole, Clotrimazole, etc.;
• triazole drugs - Fluconazole and Itraconazole;
• N-methylnaphthalene derivatives (allylamine group) - Naftifine, Terbinafine;
• combined agents - Pimafukort, Polygynax, Terzhinan, Klion-D 100;
• drugs belonging to other groups - Nitrofungin, Flucytosine, Ciclopirox, Griseofulvin, Amorolfine, Iodine preparations, etc.

Fluconazole (Diflucan, Difluzol, Mikosist) is especially widely used in the treatment of vulvovaginal candidiasis, both acute and chronic.

In the acute form of the disease, it is prescribed orally in a dose of 150 mg once, in order to stop relapses in the chronic course - also 150 mg, but 2 or 3 times with an interval of 2 or 3 days.

In addition, it is recommended to use antifungal agents locally in the form of intravaginal tablets, suppositories, solutions, and creams.

Conducting a cultural study to determine the sensitivity of the causative agent of the disease helps to choose the most effective antimycotic agent. Considering that vulvovaginal candidiasis is very often combined with inflammatory processes caused by other microorganisms, an individual treatment regimen should be selected for each patient.

Source: https://ginekolog-i-ya.ru/kandidoznyj-vulvovaginit.html

Symptoms and treatment of vulvovaginal candidiasis

One of the common problems in girls and women is vulvovaginal candidiasis, caused by opportunistic Candida fungi.

The pathology is accompanied by an inflammatory process in the vaginal area and outer genitalia. Sometimes doctors diagnose candidiasis-type vulvovaginitis in newborns.

When the first symptoms appear, you should contact a gynecologist and comprehensively treat candidiasis of the vagina and external genitalia.

Features of the disease

According to statistics, 75% of women in old age have suffered from vulvovaginal candidiasis, and this pathology ranks first among diseases of the lower organs of the genitourinary system in girls aged 1 to 8 years.

With vulvovaginal candidiasis, infection occurs with fungi of the genus Candida, which begin to actively multiply.

The process of their reproduction is accompanied by inflammation in the vaginal area, external genitalia and anal area.

Form of candidal vulvovaginitis	Peculiarities	Duration
Spicy	The symptomatic picture is clearly expressed	No more than 30 days
Subacute	Transitional form between acute and chronic	3 months
Chronic	Symptoms are mild, and the disease recurs several times a year	More than 3 months
Constant	The clinical picture does not go away even after the use of drug therapy, mild symptoms are noted
Recurrent	Symptoms recur within a short period of time after complex treatment

A smear on the vaginal flora allows you to determine candidia carriage.

In addition to the forms mentioned above, there is also candidiasis carriage, in which a woman does not show signs of deviation, but she is capable of infecting others. Such candidal vaginitis can be detected by taking a smear for analysis. Doctors say that about 20% of elderly women are carriers of a fungal infection.

Source: http://EtoGribok.ru/molochnica/nedug/kandidoznyj-vulvovaginit.html

Vulvovaginal candidiasis

Vulvovaginal candidiasis: what is it? Many women are familiar with the disease thrush. It has struck almost every woman at least once in her life. The disease discussed below is a similar concept.

Vulvovaginal candidiasis: ICD

The International Classification of Diseases assigns this disease the number 77.1 and says that it affects the woman’s vagina and vulva.

There are several techniques and methods for treating this disease. But the final decision must be made only by the doctor without fail.

Moreover, it is also necessary to note whether the disease occurs in an acute form or whether it has already entered the chronic stage.

Candidiasis or vulvovaginitis?

In order to avoid any confusion between these concepts, we need to clarify the differences a little. Candidiasis, which has a synonymous name - thrush, is understood as a fungal disease that affects the external genitalia, and less often the internal organs. Candidiasis often affects the vagina and vulva.

Vulvovaginal candidiasis is a lesion of the vulva and vagina caused by the overgrowth and proliferation of fungi from the genus Candidiasis.

They are sticky, foamy and have an unpleasant odor. With thrush, there will be very severe itching, symptoms will begin to appear even before menstruation and the discharge will be exclusively curdled.

Vulvovaginal candidiasis: symptoms

In the acute course of the disease, symptoms will manifest themselves as follows:

• There will be a burning sensation and pain during urination;
• Before your period, vaginal discharge will increase. The discharge itself is usually moderate or heavy and has a yellowish or white tint. They can be curdled or creamy. The smell is usually unpleasant;
• A woman feels intense discomfort in the genital area;
• Itching and burning are felt in the anogenital area, in the groin area, and on the vaginal mucous membranes. These sensations increase when a woman is physically active, after water procedures, when engaging in sexual intercourse and at night.

Upon examination, the doctor notices the discharge and swelling of the vagina described above along with redness. Rashes may be found on the labia.

Acute candidal vulvovaginitis: photo

The main symptoms that a patient may encounter if she has an acute form of vulvovaginitis have been described above.

But since we do not always trust doctors and, in some cases, trust the Internet more, many women, after making such a diagnosis, search for photographs of pathology on the Internet and compare them with what they have.

Sometimes this is a good way, but such photographs may not always be true. On the Internet, many things are unnecessarily exaggerated.

Yeast vulvovaginitis: causes

In principle, this concept can be considered synonymous with candidal vaginitis, since it is caused by a fungus. What is the reason for the appearance of such vulvovaginitis in women?

• Constant nervous overload and high susceptibility to stressful situations;
• Long and irrational use of antibiotics;
• Hormonal imbalances and changes in the body. It is for this reason that yeast vulvovaginitis occurs so often in pregnant women;
• Weakening of the body's defenses, which is caused by a lack of vitamins, the presence of concomitant diseases, and surgical interventions;
• Venereal diseases.

Vulvovaginal candidiasis during pregnancy

The frequency of fungal infection during pregnancy reaches forty percent, which is approximately three times higher than in those who are not pregnant. Why is this happening? The fact is that:

• During this period, a woman’s hormonal levels change greatly;
• The glycogen content in the body cells increases, and this is an excellent breeding ground for both lactobacilli and yeast infections;
• Cellular protective mechanisms are inhibited at the physiological level during pregnancy. This is necessary so that the female body does not perceive the fetus as a foreign formation and does everything possible to fully carry the pregnancy;
• The epithelial layer of the vaginal mucosa becomes more loose.

It is important to remember that vulvovaginal candidiasis poses a danger to the fetus: it threatens premature birth, infection of the fetus and its death. That is, if a woman suspects such a problem during pregnancy, she needs urgent treatment.

How to treat vulvovaginal candidiasis in women?

Vulvovaginal candidiasis: treatment - what is most important in this aspect? When making an appropriate diagnosis, a very logical question arises: how to treat vulvovaginal candidiasis? Firstly, you need to monitor your own body as closely as possible and if any suspicious symptoms appear, contact an experienced doctor. Treatment of chronic vulvovaginal candidiasis is more complex than treatment of the acute form. Firstly, it is more difficult to diagnose and it is more difficult for the woman herself to notice it. But at the same time, such vulvovaginitis is a consequence of untreated and ignored vulvovaginal candidiasis in its acute form. That is, the responsibility lies entirely with the woman herself, who did not consult a doctor at the right time or began to self-medicate.

Treatment of vulvovaginal candidiasis.

To treat the pathology, polyene antibiotics are prescribed. These are Natamycin, Mycoheptin and Levorin. Imidazole drugs, for example, Butoconazole and Econazole, are also considered effective. Among the combined products we can note Polizhinaks, Terzhinan, Klion-D.

Gynecologists often prescribe the use of intravaginal products in the form of creams, vaginal tablets and ointments. In addition, treatment of chronic vulvovaginal candidiasis includes the use of drugs that boost the body's immune forces.

Source: https://vulvovaginit.ru/kandidoznyij-vulvovaginit.html

Vulvovaginal candidiasis: pathogenesis, clinical picture, diagnosis, modern principles of therapy

Vulvovaginal candidiasis is an infection of the vulvar and vaginal mucosa caused by yeast-like fungi of the genus Candida. As a rule, it affects women of reproductive age; it is less common in girls and women in the peri- and postmenopausal period.

In recent years, the prevalence of vulvovaginal candidiasis has been steadily increasing; the share of this disease in the structure of infectious lesions of the vulva and vagina is 30 - 45%. Currently, vulvovaginal candidiasis ranks second among all vaginal infections and is one of the most common reasons for women seeking medical help.

In the United States, 13 million cases of this disease are recorded annually. During pregnancy, the prevalence of this infection reaches 40 - 46% (Horowitz BJ

, 1991), it is one of the reasons for the development of pregnancy complications (the number of spontaneous miscarriages in early pregnancy, the threat of termination of pregnancy increases by 1.5 times, the risk of infection of the fetus and newborn - by 2.4 times). Vulvovaginal candidiasis is found in 30% of cancer patients and in 64% of patients with various endocrine disorders.

According to JS Bingham (1999), 75% of women of reproductive age have at least one episode of vulvovaginal candidiasis during their lifetime, and 50% have a repeated episode. 5% of women on the planet suffer from recurrent vulvovaginal candidiasis.

The causative agent of vulvovaginal candidiasis is yeast-like fungi of the genus Candida. Fungi of the genus Candida are opportunistic microorganisms that live as saprophytes on the skin and mucous membranes of healthy people.

Currently, more than 170 biological species of yeast-like fungi have been described, among which in the vast majority of cases (85 - 90%) the causative agent is C. albicans (Sobel JD, 1998).

Among other Candida species, C. glabrata (according to the old classification - C. torulopsis), C. tropicalis, C. parapsilosis, C. krusei, C. guilliermondi are of clinical importance, much less often - C.

pseudotropicalis and Saccharomyces cerevisiae.

When prescribing broad-spectrum antibiotics, it is necessary to take into account that they suppress not only pathogenic bacteria, but also lactobacilli located in the vagina, which are physiological antagonists of yeast-like fungi (lactobacillus suppresses the attachment of Candida to epithelial cells and their reproduction).

As a result, the pH of the vaginal contents increases (shifts to the alkaline side), and the process of self-cleaning of the vagina is disrupted. Additionally, Candida has the ability to use antibiotics as food sources.

This creates favorable conditions for the active reproduction of Candida in the woman’s genitals.

The facts of the development of vulvovaginal candidiasis during pregnancy are also well known. The first episode of vulvovaginal candidiasis occurs in many women during pregnancy.

The frequency of vulvovaginal candidiasis in pregnant women reaches 40 - 46% (Horowitz BJ, 1991). Such high rates are due to changes in hormonal balance during pregnancy.

The highest degree of colonization is observed in the last trimester and in first-time mothers.

Vulvovaginal candidiasis is one of the diseases of modern civilization.

The development of vulvovaginal candidiasis is facilitated by wearing underwear made of synthetic fabrics that tightly fits the body, resulting in a microclimate with high humidity and temperature, which leads to maceration of the stratum corneum of the skin, the emergence of thermostatic conditions for the development of local microflora, including intestinal, where among fungi C. albicans makes up over 95% (Antonyev A.A.

, 1985). The virulence of C. albicans increases under conditions of high humidity (sweating). Therefore, wearing tight synthetic underwear, washing with a pressure shower, using sprays, or using pads is a trigger for the development of a hypersensitivity reaction and predisposes to Candida colonization.

Fungi of the genus Candida can be isolated from the vagina of practically healthy women in the absence of clinical signs of vulvovaginal candidiasis (carriage). Under certain conditions, under the influence of exogenous and/or endogenous factors, these fungi become pathogenic, causing disease.

Despite the existence of numerous studies, the modes of infection and the route of transmission of the pathogen in vulvovaginal candidiasis remain the subject of debate. Yeast-like fungi enter the woman’s genital tract from the intestines, upon contact with exogenous sources of infection, through household objects.

There is evidence that in recurrent vulvovaginal candidiasis, the gastrointestinal tract serves as a permanent reservoir of fungi and a source of reinfection of the vagina.

In cases where fungi are sown from the vagina, they are almost always found in feces, and in most women both vaginal and intestinal strains are identical.

The pathogenesis of vulvovaginal candidiasis is complex and not well understood. Considering the fact that strains of C.

albicans isolated from patients with vulvovaginal candidiasis and from carriers do not differ significantly in a number of biochemical characteristics, we can conclude that the state of the macroorganism plays a leading role in the development of vulvovaginal candidiasis, and not the properties of the pathogen. The trigger for the development of the disease is not a change in the properties of the fungus, but a decrease in the resistance of the host organism.

The following stages are distinguished in the development of candidal infection:

• adhesion of fungi to the surface of the mucous membrane;
• colonization of the mucous membrane by fungi;
• invasion into the epithelium, overcoming the epithelial barrier of the mucous membrane, entering the connective tissue of the lamina propria, overcoming tissue and cellular protective mechanisms;
• penetration into blood vessels and hematogenous dissemination with damage to various organs and systems.

This sequence reflects all stages of the development of severe candidiasis, however, in milder cases, the infection may stabilize at one of these stages.

With vulvovaginal candidiasis, the infectious process often affects only the superficial layers of the vaginal epithelium.

Due to the dynamic balance existing at this level between microorganisms (fungi), which strive but cannot penetrate the deeper layers of the mucous membrane, and the macroorganism, which tries, but is not able to completely eliminate the pathogen, the infection can persist for decades. And loss of balance can lead either to an exacerbation of the disease, or, conversely, to remission or recovery.

Currently, there are three clinical forms of vulvovaginal candidiasis:

• candidiasis;
• acute form of vulvovaginal candidiasis;
• chronic (recurrent) vulvovaginal candidiasis.

Candidiasis is characterized by the absence of symptoms of the disease. However, during microbiological examination in vaginal discharge, yeast-like fungi of the genus Candida are present in small quantities (

Source: https://www.lvrach.ru/2002/11/4529797/